Definition and causes
Infertility has been with World Health Organization (WHO) classified as a disease and usually defined by the couple after a 1-year study was not pregnant. Completely rigorous Monday differentiate between infertility and childlessness, as for example, couples who already have a child may subsequently be infertile, but obviously not have children.
Typically, approximately. 50% of couples who are trying to achieve pregnancy, become pregnant after half a year, while around. 90% of pregnant after one year.
There may be several reasons why a couple can not achieve pregnancy. The reasons are around. just as frequently in women as in men.
- In the woman may be the reason that shenot produce eggs. This may be due to congenital lack of precursors of eggs, for example. by Turner syndrome, where the woman is missing one X chromosome. Deusuden it may be because she hasearly menopauseThat she hashormonal disordersor dysfunctions that as polycystic ovary syndrome (PCO).
- There may bestructuralcauses in women, which reduces fertility, for example. after a chlamydia infection, the egg heads can be destroyed by arvæv. Other causes of egg-heads may be that after the surgical procedure can be together waxing, prevent passage of eggs, or they can be operated enddog away. Structural causes in the womb, for example. fibroids in the uterus, can reduce the possibility that the fertilized eggs can become lodged in livmoderslimhinden, ie. reproductive system.
- Reduced semen quality in the man or the total absence of sperm in ejaculation (release) can lead to infertility. Reduced semen quality may include, due to environmental impact. Seat quality is measured both in the number of sperm in ejakulatet, but also in each of spermatozoa movement and appearance. Lack of sperm by ejakuluation may be due to previous infections in man.
Often it is a combination of several factors that make the couple is infertilt, and can sometimes cause does not exist. For some couples where both partners have each had a child with another partner, can also cause infertility. This may be due to some antibodies in the woman's mucous membrane that reacts to her new partner's sperm, but not at the former partners.
Precautions and diagnosis
The diagnosis is usually made by the lack of pregnancy after 1 year, and investigations started in the rule until after 2 years, unless there are very obvious reasons, prevent natural pregnancy.
The determination of infertility starts with the practitioner who will interview for a particular previous infections and operations. Also questioned in particular eating habits, and advised on eating disorders and obesity, since both reduces fertility. Moreover investigation, with particular gynecological examination, this would usually also involve an inoculation for particular Chlamydia.
The woman may also be borne by the fact that she measures the temperature throughout the menstrual cycle, when this rises just after ovulation. She can recognize a urinstix, ie. a piece of filter paper with the indicator box on that show growth in one of the hormones before ovulation (the luteinizing hormone). Death can take blood samples for hormone progesterone.
The anatomical relationship can be teased by reference to a røngtenklinik, where you can create an X-ray production of egg heads and visualize any closing.
The man is also being reviewed, and here examined testis size and whether they are in the purse.
His semen quality can be examined using a microscope at a special laboratory.
Further investigation would be carried out under Special. Here is the woman in particular ultrasound scan for any. polycystic ovary syndrome (PCO), and there can be more specific blood tests.
Treatment of infertility
- If infertility due to lack of development of eggs caused by lack of hormonal stimulation or inadequate response to female hormones, attempted hormonal stiumlation. Mainly with a hormone (klomifen), which binds to receptors in the brain, where it increases the release of FSH (folikelstimulerende hormone), which stimulates the ovaries to produce multiple eggs. If this has no effect, the ovaries are stimulated with a synthetic FSH. Read also about hormones here.
- If infertility is due to an anatomical defect, for example. closed fallopian tubes, there is often no reason for further investigation. It is then obliged to launch artificial fertilization, where eggs are harvested from the woman after stimulation with hormones. This is done by ultrasound guided puncture, which introduced a needle in an ovary, in one of the mature folikler, and the egg is sucked out. This is done through the vagina.
There are different types of artificial insemination:
- Intrauterine insemination (IUI):If there is the normal passage of egg heads, and the man has moderately impaired fertility (over 2 million. Spermatozoa per normal. Ml), can insemination attempts. Here is injected purified sperm into the uterus through a catheter, very close to indmundingen of egg heads, just before ovulation. This might be. gåes ahead of hormonal stimulation, as described above. If this does not result in pregnancy after 6 times (the number may vary), should consider other method. The method is called IUI (intrauterine or in
- Micro Insemination:By sharply reduced semen quality (less than 2 million. Spermatozoa per. Ml), can be used micro-insemination (ICSI: intracytoplasmic sperm injection). Here are harvested eggs as described above, then under a microscope to inject a single sperm into the egg with a very thin needle. Then put the fertilized egg in the uterus. Often set up more than one, since the risk that the egg is not growing fast and becomes an embryo, is significant. The number of eggs varies keen, because there is significant increase h
- IVF (test tubes method "):If the woman's fallopian tubes are tillukkede, but the man has normal sperm quality, you can apply the method to popular called "test tube" method (IVF: in vitro fertilization). Here are harvested eggs, as described above, then in a test tube, add sperm. Then set up more than two embryos in the womb. This is because the risk of multiple pregnancy are substantial.
- FER:Often, when harvesting the eggs, be more usable eggs, than to be put up. These may, after fertilization, frozen and used later to set-up where the first setup is not completed. This is called FER (frozen embryo replacement).
- Donoræg:If the woman does not produce eggs, which can set up a fertilized egg from a donor. Her eggs are harvested as previously described by another woman, and this may be suspended after fertilization of the woman seeking pregnancy.
Select and complications
The risk of multiple gestations (mostly twins) is significantly increased by artificial insemination, as a rule set up more than a fertilized egg.
Artificial insemination in figures
In 2004, Denmark in 2927 referred the women for artificial insemination by one of the above methods. All were first referred. There were a total of 9,173 treatments. Of the 9,173 treatments will be booted several treatments on the same woman, each woman can have several treatments, if not successful the first time. There were 1,525 single births and 408 multiple births, which underscores the incidence of multiple gestations by artificial insemination. The total number of births
(Source: the number of births and treatment for infertility Liger: Health Authority